State-level policies and receipt of CDC-informed opioid thresholds among commercially insured new chronic opioid users

Martin J. Calabrese; Fadia T. Shaya; Francis Palumbo; Mary Lynn McPherson; Ester Villalonga-Olives; Zafar Zafari; Ryan Mutter

doi:10.5055/jom.0824

Authors

Martin J. Calabrese, PharmD, PhD https://orcid.org/0000-0003-4304-396X
Fadia T. Shaya, PhD, MPH
Francis Palumbo, PhD, JD
Mary Lynn McPherson, PharmD, PhD, BCPS, FAAHPM
Ester Villalonga-Olives, PhD, MSc
Zafar Zafari, MSc, PhD
Ryan Mutter, PhD

DOI:

https://doi.org/10.5055/jom.0824

Keywords:

chronic opioid use, prescription opioids, Prescription Drug Monitoring Program, cannabis

Abstract

Objectives: To evaluate the association of state-level policies on receipt of opioid regimens informed by Centers for Disease Control and Prevention (CDC) morphine milligram equivalent (MME)/day recommendations.

Design: A retrospective cohort study of new chronic opioid users (NCOUs).

Setting: Commercially insured plans across the United States using IQVIA PharMetrics® Plus for Academics database with new chronic use between January 2014 and March 2015.

Participants: NCOUs with ≥60-day coverage of opioids within a 90-day period with ≥30-day opioid-free period prior to the date of the first qualifying opioid prescription.

Interventions: State-level policies including Prescription Drug Monitoring Program (PDMP) robustness and cannabis policies involving the presence of medical dispensaries and state-wide decriminalization.

Main outcome measures: NCOUs were placed in three-tiered risk-based average MME/day thresholds: low (>0 to <50), medium (≥50 to <90), and high (≥90). Multinomial logistic regression was used to estimate the association of state-level policies with the thresholds while adjusting for relevant patient-specific factors.

Results: NCOUs in states with medium or high PDMP robustness had lower odds of receiving medium (adjusted odds ratio [AOR] 0.74; 95 percent confidence interval [CI]: 0.62-0.69) and high (AOR 0.74; 95 percent CI: 0.59-0.92) thresholds. With respect to cannabis policies, NCOUs in states with medical cannabis dispensaries had lower odds of receiving high (AOR 0.75; 95 percent CI: 0.60-0.93) thresholds, while cannabis decriminalization had higher odds of receiving high (AOR 1.24; 95 percent CI: 1.04-1.49) thresholds.

Conclusion: States with highly robust PDMPs and medical cannabis dispensaries had lower odds of receiving higher opioid thresholds, while cannabis decriminalization correlated with higher odds of receiving high opioid thresholds.

Author Biographies

Martin J. Calabrese, PharmD, PhD

Department of Practice, Sciences, and Health Outcomes Research, University of Maryland Baltimore School of Pharmacy; Center for Medicare, Centers for Medicare & Medicaid Services, Baltimore, Maryland

Fadia T. Shaya, PhD, MPH

Department of Practice, Sciences, and Health Outcomes Research, University of Maryland Baltimore School of Pharmacy, Baltimore, Maryland

Francis Palumbo, PhD, JD

Department of Practice, Sciences, and Health Outcomes Research, University of Maryland Baltimore School of Pharmacy, Baltimore, Maryland

Mary Lynn McPherson, PharmD, PhD, BCPS, FAAHPM

Professor, Department of Practice, Sciences, and Health Outcomes Research, University of Maryland Baltimore School of Pharmacy, Baltimore, Maryland

Ester Villalonga-Olives, PhD, MSc

Department of Practice, Sciences, and Health Outcomes Research, University of Maryland Baltimore School of Pharmacy, Baltimore, Maryland

Zafar Zafari, MSc, PhD

Assistant, Department of Practice, Sciences, and Health Outcomes Research, University of Maryland Baltimore School of Pharmacy, Baltimore, Maryland

Ryan Mutter, PhD

Congressional Budget Office, Health Analysis Division, Washington, DC

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Appendix references

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